Business Analyst - US Healthcare RCM

Job Description – Business Analyst (US Healthcare RCM)

Role Summary

Shift: 12PM - 9PM ISD

MODE: WFO

The Business Analyst (BA) – US Healthcare Revenue Cycle Management (RCM) supports provider-side RCM operations with a strong focus on multi-specialty practices (including Radiology, Behavioral Health, and Physician Groups). The role partners with Operations, Billing, AR, Denials, Credentialing, and Client Stakeholders to identify revenue leakage, improve workflows, define reporting and automation requirements, and drive measurable improvements across cash, AR, denials, and compliance.

Key Responsibilities

 1. Business & Requirements Analysis - Gather and document business requirements from eligibility, authorization, charge entry, coding, billing, AR, denials, payment posting, and credentialing teams. - Develop process flows (AS-IS / TO-BE), SOPs, and acceptance criteria aligned to RCM workflows. - Translate operational requirement

2. RCM Analytics & Reporting - Design and maintain operational dashboards covering AR aging, DNFB, denial rates, clean claim rate, net collection rate, and cash trends. 

- Perform payer-wise and denial-category analysis (auth, eligibility, medical necessity, timely filing, coding, bundling, COB). 

- Conduct expected vs paid analysis and identify underpayments and revenue leakage.

3. Denials Management & Revenue Integrity

 - Analyze denial root causes and recommend preventive controls and corrective actions. 

- Support development of payer-specific denial play

4. Process Improvement & Governance 

 - Identify inefficiencies and rework across end-to-end RCM workflows and recommend process improvements. - Establish trackers, control points, and SLA/KPI governance

5. Systems & Data Enablement

 - Work with PM/EHR, clearinghouse, and BI tools to validate data accuracy and metric definitions.

 - Support logic validation for 837/835/277 files, CARC/RARC mapping, and denial categorization.

Required Skills & Experience 

 - 8+ years of experience in US Healthcare RCM (provider-side preferred). 

- Strong knowledge of end-to-end RCM workflows and payer adjudication logic.

 - Advanced Excel skills; experience with Power BI/Tableau preferred.

 - Strong documentation, analytical, and stakeholder communication skills.

Key KPIs - Reduction in denial rate and AR days. 

- Improvement in clean claim rate and net collection rate. 

- Cash acceleration and underpayment recovery.

 - Timely and accurate delivery of reports and insights.

 

Susmita Majumder

Senior Executive – Talent Acquisition

Human Resource

CALPION | Experience Excellence

Connect me

Susmita.majumder@calpion.com

91-(7638802666)